| Name: | Fort Payne Home Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Mar 2006 (19 years ago) (Companies founded in March 2006) |
| Entity Number: | 000-246-150 |
| Register Number: | 000246150 |
| Historical Names: |
Fort Payne Home Care Corporation
|
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104 |
Activities
OPERATE/MANAGE VARIOUS HEALTH CARE FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790720076 | 2006-06-19 | 2020-07-28 | PO BOX 51266, LAFAYETTE, LA, 705051266, US | 1706 GLENN BLVD SW STE 3, FORT PAYNE, AL, 359683544, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 337-233-1307 |
| Fax | 3374434154 |
| Phone | +1 256-844-2882 |
| Fax | 2568446591 |
Authorized person
| Name | MR. NICHOLAS GACHASSIN III |
| Role | SECRETARY/TREASURER |
| Phone | 3372331307 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | CON1340 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DEK7093A |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2016-09-28 | Name Change | Fort Payne Home Care Corporation | Fort Payne Home Care, LLC |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
